HomeMy WebLinkAboutContracts & Agreements_244-2005_CCv0001.pdf INDEPENDENT CONTRACTOR AGREEMENT
This Agreement is made and entered into this 61h day of December, 2005 by and
between the City of Redlands, a municipal corporation (hereinafter "City") Developing
Aging Solutions with Heart, Inc., (DASH, Inc.) (hereinafter"Contractor").
RECITALS
WHEREAS, Contractor has expressed an interest in providing geriatric care
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management services,including counseling,educational assistance,and access to community
resources for both dependent adults with Alzheimers and their caregivers;
WHEREAS, Contractor has represented to City that it has the requisite experience,
special knowledge and expertise similar to others in the industry conducting these services,
NOW,THEREFORE,in consideration of the mutual promises contained herein,the
City and Contractor hereby agree as follows:
AGREEMENT
Section 1. Services.
A. City hereby authorizes Contractor to provide geriatric care management
services, including counseling, educational assistance, and access to
community resources for both dependent adults with Alzheimers and their
caregivers;
B. Contractor shall determine the method, details and means of performing the
above-described services and shall advise City of the same prior to
commencing any activities under this Agreement. Contractor further agrees
to perform such services to the best of its ability and in an efficient, safe and
competent manner.
C. As compensation for conducting these services, City shall reimburse the
contractor for services necessary to implement this program. Federal, State,
County and City rules and regulations will apply. Compensation shall not
exceed $5,000.00.
D. Contractor shall submit to City a complete record of the services performed
including, but not limited to: copies of invoices, agreements, payroll
expenses, administrative records, advertisements, and backup materials. A
detailed account of the services performed,person(s)performing services and
cost breakdown shall also be provided to the City. Administration and
personnel records shall be available for examination by the City.
E. Contractor shall submit to City with each request for reimbursement
documentation in compliance',,vith the requirements listed in 24 CFR 570.503
including: Agreements with Subrecipients;Statement of Work,Records and
Reports; Program Income; Uniform Administrative Requirements; Other
Program Requirements,Conditions for Religious Organizations;Suspension
and Termination; Reversion of Assets.
F. Contractor shall submit to City, with each request for reimbursement,
documentation that at least 51% of the adult dependents served are from
income qualifying households. In order to document the number of low and
moderate income adult dependents benefiting from the program, a
Beneficiary Qualification Statements form,a copy of which is attached hereto
and incorporated herein by reference as Exhibit "A", must be completed by
Contractor for each adult dependent that benefits from the Program. Using
the Beneficiary Qualification Statements prepared for each adult dependent,
Contractor must complete the Monthly Program Progress Report form,a copy
of which is attached hereto and incorporated herein by reference as Exhibit
"B", for every month that CDBG funds are expended, and submit these
Monthly Program Progress Reports with Contractor's monthly reimbursement
request to the City. Copies of all submitted forms must be retained in
Contractor's records for a minimum period of three(3)years from December
7, 2005.
G. Contractor will submit all final claims for reimbursement to City no later than
June 30, 2006.
H. The City of Redlands will submit a final Request for Reimbursement for the
program year no later than July 21, 2006. After July 31, 2006 any balance
remaining in this account will be reprogrammed.
Section 2. Independent Contractor.
It is the express intention of the parties hereto that Contractor is an independent
contractor and not an employee or agent of City. Nothing in this Agreement shall be
interpreted or construed as creating or establishing a relationship of employer and
employee between Contractor and City. Both parties acknowledge that Contractor is
not an employee for State tax, Federal tax or any other purpose.
Section 3. Contractor's Emplovees.
A listing of all Contractor's employees and agents -V-,,ho may participate in the
performance of Contractor's obligations hereunder is attached hereto as Exhibit"C"
and incorporated herein by this reference. No other employees or agents of
Contractor shall participate in the performance of services hereunder without the
prior written consent of City.
Section 4. Termination.
City shall have the right to terminate this Agreement,with or without cause,
upon twenty(20)day's prior written notice to Contractor. City shall have no liability
for any claims or damages resulting to Contractor as a result of any exercise by City
of its right to terminate this Agreement.
Section 5. Insurance and Indemnification
5.1 Contractor's Insurance to be Primary
All insurance required by this Agreement is to be maintained by Contractor for the
duration of this Project and shall be primary with respect to City and non-contributing to any
insurance or self-insurance maintained by the City. Contractor shall not perform any
Services pursuant to this Agreement unless and until all required insurance listed below is
obtained by Contractor. Contractor shall provide City with Certificates of Insurance and
endorsements evidencing such insurance prior to commencement of work. All insurance
policies shall include a provision prohibiting cancellation of the policy except upon thirty
(30) days prior written notice to City.
5.2 Workers' Compensation and Employer's Liability,
A. Contractor shall secure and maintain Workers' Compensation and
Employer's Liability insurance throughout the duration of this Agreement in
amounts which meet statutory requirements with an insurance carrier
acceptable to City.
R Contractor expressly waives all rights to subrogation against City,its officers,
employees and volunteers for losses arising from work performed by
Contractor for City by expressly waiving Contractor's immunity for injuries
to Contractor's employees and agrees that the obligation to indemnify,defend
and hold harmless provided for in this Agreement extends to any claim
brought by or on behalf of any employee of Contractor. This waiver is
mutually negotiated by the parties. This shall not apply to any damage
resulting from the sole negligence of City,its agents and employees. To the
extent any of the damages referenced herein were caused by or resulted from
the concurrent negligence of City, its agents or employees, the obligations
provided herein to indemnify, defend and hold harmless is valid and
enforceable only to the extent of the negligence of Contractor, its officers,
agents and employees.
53 Comprehensive General Liabilitv Insurance. Contractor shall secure and
maintain in force throughout the duration of this Agreement comprehensive general liability
insurance with carriers acceptable to City. Minimum coverage of one million dollars
($1,000,000) per occurrence and two million dollars ($2,000,000, aggregate for public
liability, property damage and personal injury is required. Contractor shall obtain an
endorsement that City shall be named as an additional insured.
5.4 Professional Liability Insurance. Contractor shall secure and maintain
professional liability insurance throughout the duration of this Agreement in the amount of
one million dollars ($1,000,000)per occurrence.
5.5 Business Auto Liability Insurance. Contractor shall have business auto
liability coverage,with minimum limits of I million($1,000,000)per occurrence,combined
single limit for bodily injury liability and property damage liability. This coverage shall
include all consultant owned vehicles used on the project,hired and non-owned vehicles,and
employee non-ownership vehicles. Contractor shall obtain an endorsement that City shall be
named as an additional insured.
5.6 Assignment and insurance Requirements. Contractor is expressly prohibited
from subletting or assigning any of the services covered by this Agreement without the
express written consent of City. In the event of mutual agreement between parties to sublet a
portion of the Services,the Contractor will add the subcontractor as an additional insured and
provide City with the insurance endorsements prior to any work being performed by the
subcontractor. Assignment does not include printing or other customary reimbursable
expenses that may be provided in this Agreement.
5.7 Hold Harmless and Indemnification. Contractor shall defend,indemnify and
hold harmless City,its elected officials,officers,employees and agents,from and against any
and all actions, claims, demands, lawsuits, losses and liability for damages to persons or
property, including costs and attorney fees, that may be asserted or claimed by any person,
firm, entity, corporation, political subdivision or other organization arising out of or in
connection with Contractor's negligent and/or intentionally wrongful acts or omissions under
this Agreement; but excluding such actions, claims, demands, lawsuits and liability for
damages to persons or property arising from the sole negligence or intentionally wrongful
acts of City, its officers, employees or agents.
Section 6. Health Insurance Portability And Accountability Act of 1996
Pursuant to the Health Insurance Portability And Accountability Act of 1.996
(HIPAA), regulations have been promulgated governing the privacy of individually
identifiable health information. The HIPAA Privacy Regulations specify requirements with
respect to contracts between an entity covered under the HIPAA Privacy Regulations and its
Business Associates. A Business Associate is defined as a party that performs certain
services on behalf of, or provides certain services for, a Covered Entity and, in conjunction
therewith, gains access to individually identifiable health information. Therefore, in
accordance with the HIPAA Privacy Regulations,Contractor shall comply,,with the terms and
conditions as set forth in the attached Business Associate Agreement, Exhibit "D" hereby
incorporated by this reference.
Section 7. Entire NarreemenvAjodification. This Agreement represents the entire
Agreement of the parties hereto as to the matters contained herein. Any modification of this
Agreement will be effective only if it is in writing and signed by the parties hereto.
Section 8. Assigpment. This Agreement shall not be assigned without the prior
written consent of City. Any assignment, or attempted assignment, without such prior
written consent, shall be null and void and, at the option of City, result in the immediate
termination of this Agreement.
Section 9. Attorney's Fees. In the event any action is commenced to enforce or
interpret the terms or conditions of this Agreement,the prevailing party shall, in addition to
any costs or other relief, be entitled to recover its reasonable attorneys' fees.
Executed this 6th day of December 2005.
City of Redlands
Date: December 6, 2005
r, City of Redlands
on Harrison
Attest:
Louie f'oyzer, City,
City of Redlands
Developing Aging Solutions with Heart, Inc.
(DASI-1)
J
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Date. C'
i:ca\1em\agreementS\RCMA 5
It
EX, IT I (a) of 2 Q A "
COUNTY OF SAN BERNARDINO DEPARTMENT OF COMMUNITY DEVELOPMENT AND HOUSING
Project/Activity Title: Case Number:
Redlands: Geriatric Care Services-DASH 111-28127/2288
Name/Address of Contractor Agency: Date of Issue:
Developing Aging Solutions with Heart, Inc. Original:
P.O. Box 8370 Amendment#3 Beginning 7/01/05
Redlands, CA 92375-1570
BENEFICIARY QUALIFICATION STATEMENT
This form has the purpose of providing information needed to qualify the use of federal Community
Development Block Grant (CDBG) funds for the project/activity described above. This statement must be
completed and signed by the person (or legal guardian of the person)requesting to receive benefits from the
described project/activity. Only one statement per person, per year is required.
Please answer each of the following questions.
1. This question helps you determine the size of your household. For this question a household is a group
of related or unrelated persons occupying the same house with at least one member being the head of the
household. Renters,roomers, or borders cannot be included as household members. How many persons
are in your household?
2. This question asks if you are from a low- and moderate-income household. For this question a list of the
2005 LOW-INCOME and LOW-AND MODERATE-INCOME categories* are presented below. Please
add up the combined gross annual income of all persons in your household from all sources of income.
In the blank provided, write yes or no,that your combined gross annual income is equal to or less
than the LOW-INCOME amount for the number of persons in your household:.
In the blank provided, write, yes or no, if your combined gross annual income is equal to or less
than the LOW- AND MODERATE-INCOME amount for the number of persons in your
household.
Number of Persons in Your Household
A
2 3 It
LOW-INCOME $19,500 $22,250 $25,050 $27,850
LOW- AND MODERATE- $31,200 $35,650 $40,100 $44,550
INCOME (COMBINED)
Number of Persons in Your Household
5 6 7 8
LOW-INCOME $30,050 $32,300 $34,500 $36,750
LOW- AN-D MODERATE- $48,100 $51,700 $55,250 $58,800
INCOME (COMBINED)
Page 1 of 2
EXHIBIT I (a) of 2
COUNTY OF SAN BERNARDINO DEPARTMENT OF COMMUNITY DEVELOPMENT AND HOUSING
3. Please indicate how you identify yourself by checking only one (1) of the following,choices:
Non-
Hispanic Hispanic
White
Black/African American ❑ ❑
Asian
American Indian/Alaskan Native ❑ ❑
Native Hawaiian/Other Pacific Islander r_1
American Indian/Alaskan Native &White ❑ ❑
Asian & White E] F]
Black/African American & White ❑ ❑
American Indian/Alaskan Native &Black/African American M E]
Balance/Other ❑ D
4. Please check whether you belong to a Female Headed Household: ❑Yes ❑No
5. Please describe the condition that would qualify you as being considered in one of the following presumed
low- and moderate-income categories: abused child, battered spouse, elderly person, homeless person,
disabled adult, illiterate person, or migrant farm worker:
(description)
ACKNOWLEDGMENT AND DISCLAIMER
I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSEHOLD
STATEMENTS MADE ON THIS FORM ARE TRUE.
NAME: DATE:
ADDRESS: CITY: ZIP:
SIGNATURE: PHONE:
The information you provide on this form is for Community Development Block Grant (CDBG)
program purposes only and will be kept confidential.
*Taken from 2005 Section 8 Low-Income and Very Low-Income Limits.
Page 2 of 2
EXHIBIT IN of 2
COUNTY OF SAN BERNARDINO DEPARTMENT OF COMMUNITY DEVELOPMENT AND HOUSING
Project/Activity Title: Case Number:
Redlands: Geriatric Care Services—DASH 111-28127/2288
Name/Address of Contractor Agency: Date of Issue:
Developing Aging Solutions with Heart, Inc. Original:
P.O. Box 8370 Amendment#3 Beginning 7/01/05
Redlands,CA 92375-1570
DECLARACION DE LA CALIFICACION DEL BENEFICIAR10
Esta forma tiene el prop6sito de proporcionar la informaci6n necesaria para calificar el use de los fondos
federales del bloque del desarrollo de la comunidad(CDBG) para el proyecto/actividad descrito arriba. Esta
declaraci6n se Bebe flenar y firmar por la persona (o ]a tutela legal de la persona) que solicita para recibir
beneficios del proyecto/actividad descrito. Solarnente una declaracion por persona, por aho se requiere.
Conteste por favor a cada una de las preguntas siguientes.
1. Esta pregunta le ayuda a determinar el tamafio de su casa.
En esta pregunta un hogar es un grupo de personas relacionadas o sin relaci6n que ocupan la misma
casa por to menos con un miembro que es la cabeza de la casa. Los inquilinos no se pueden incluir
coma miembros de la casa. ZCudntas personas viven en su casa?
2. Esta pregunta explica si usted es, de un hogar de ingresos bajos y moderados.
Para esta pregunta la lista de 2005 de categorfas de BAJOS-INGRESOS y del PUNTO BAJO Y de
INGRESOS-MODERADOS *se presenta abajo. Sume por favor para arriba los ingresos brutos
anuales combinados, de todas las personas en su hogar y de todas ]as fuentes de los ingresos. En el
espacio en blanco, escriba sf o no, si su ingreso anual grueso combinado es igual o menos que la
cantidad de INGRESO-BAJO para el ndmero de personas en su casa:
En el espacio en blanco, escriba, sf o no, si sus ingresos brutos anuales combinados son igual o menos
que ]a cantidad de INGRESOS BAJOS Y MODERADOS para el mJimero de personas en su casa.
Numero de Personas en su Hogar
1 2 3 4
INGRESOS-BAJOS $19,500 $22,250 $25,050 $27,850
fNGRESOS-BAJOS Y $31,200 $35,650 $40,100 $44,550
MODERADOS (COMBENADOS)
Numero de Personas en su Hogar
5 6 7 8
fiNGRESOS-BAJOS $30,050 $32,300 $34,500 $36,750
INGRESOS-13AJOS Y $48,100 $51,700 $55,250 $58,800
MODERADOS (COMBINADOS)
1 of 2
EXHIBIT 1(b) of 2
COUNTY OF SAN BERNARDINO DEPARTMENT OF COMMUNITY DEVELOPMENT AND HOUSING
3. Indique por favor tomo se identifica usted, marcando solamente una (1) de las opciones siguientes:
No-
Hispano Hispano
Blanco ❑ M
Negro/Afro Americano R
Asidtico F]
Indio Americano/Nativo de Alaska
Nativo Hawaiano/Otra Isla del Pacffico
Indio Americano/Nativo de Alaska& Blanco
Asiatico & Blanco
Negro/Afro Americano &Blanco
Indio Americano/Nativo de Alaska&Negro/Afro Amer. ❑
Balance/Otro
4. Marque por favor si usted pertenece a un hogar encabezado femenino: ❑Si ❑No
5. Describa por favor]a condici6n que le calificarfa tomo siendo considerado en una de las categories de presumidos
ingresos bajos y moderados siguientes: nifio abusado, esposo estropeado, persona mayor, persona sin hogar, adulto
incapacitado, persona analfabeta, o trabajador migratorio de granja: (descripci6n)
RECONOCIMIENTO Y NEGACION
CERTIFICO BAJO PENA D►E PERJURIO QUE LAS DECLARACIONES HECHAS EN ESTA FORMA,
ACERCA DE LOS INGRESOS Y DE LAS CUENTAS DE LA CASA SON VERDADERAS.
NOMBRE: FECHA:
DOMICILIO: Cf DAD: CODIGO:
FIRMA: TELtFONO:
La informaci6n que usted proporciona en esta forma es para los propo'sitos del programa de fondos del
bloque del desarrollo de la comunidad (CDBG) solamente y sera mantenida confidential
*Tornado de 2005 Secci6n 8 Ingresos bajos.
2 of 2
q
EXHIBIT 2 of 2
COUNTY OF SAN BERNARDINO DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
Project/Activity Title: Case Number:
Redlands: Geriatric Care Services—DASH 111-28127/2288
Name/Address of Contractor Agency: Date of Issue:
Developing Aging Solutions with Heart, Inc. —Original:
P.O. Box 8370 Amendment#3 Beginning 7/01/05
Redlands, CA 92375-1570
MONTHLY PROGRAM PROGRESS AND DIRECT BENEFIT REPORT
For the Month of 200
PART 1: MONTHLY PROGRAM PROGRESS REPORT
A.Units of Service Provided and Description
Under each type of service listed below,summarize what your program has accomplished during this month. Include location,number
of persons served, servicesfbenefits provided, and a description of the clients served. Also report the number of"Units of Service"
provided,as defined in the Project/Activity Description(Exhibit I of the agreement).
Type of Service: Units of Service:
I.Geriatric Care Management: Goal/mo.: 10 Actual/mo.:
(One adult dependent equals one unit of service).
2. Goal/mo.: Actual/mo.:
B.Monthly Beneficiary Count(may include individual persons or households previously counted during this grant/program year)
Total number of beneficiaries(clients/participants) served this month (choose one category only):
Persons (#of P) Households (#of H)
PART 11: DIRECT BENEFIT REPORT
Direct Benefit Statistics(Unduplicated first-time client counts since start of contract;taken from Beneficiary Qualification Statement forms)
Enter the number of first-time program beneficiaries directly assisted this month
Count only as: ❑Individual Persons or ❑Households(check one box)
Low-Income(only): Low-and Moderate-Income(combined All Beneficiaries*:
Racial Identity Categories Non- Non-
Hispanic Hispanic Hispanic Hispanic
(a) (b) (c) (d)
White American Indian/Alaskan Native&White
Black/African American Asian&White
Asian Black/African American&White
American Indian/Alaskan Native Amer. Indian/Alaskan Native&Black/African Amer.
Native Hawaiian/Other Pacific Islander Balance/Other
*Grand Total of Racial Identity Categories.Sum of columns a,b,c,and d should equal the"All Beneficiaries"total above:
Female Headed Households:
Signed —Title Date
Printed Name Telephone No./Ext.
Board of Directors
anf
Members
Officers Developing Aging Solutions with Heart, Inc.
President
Al Braswell, Ph.D
13600 Diamond Point
Yucaipa, Ca. 92399
Vice-PresWmt
Larraine Townend, KCI
11750 Mt Vernon Ave.
Grand Terrace, Ca 92313
Secretaryffremurer
Pat Jones, R,N., Ph.D.
1338 Elizabeth St.
Redlands, Ca. 92373
Members
Anna Manning Gloria Rojas
1795 W. Williams St PO Box 7027
Banning, Ga. 92220 Loma Linda, Ca- 92354
Edna Skeens Annette Lutters
12459 4th Street 975 California St.
Yucaipa, Ga. 92399 Calimesa, Ca 92320
Irene Luna
10961 Desert Lawn#83 Charlie Law
Calimesa, Ca. 92320 Evelyn Law
Ceres Valley 12700 2nd Street#43
1182 Bel Air court Yucaipa, Ca. 92399
Banning, Ca 92220